An elevated coronary artery calcification score (CACS) is associated with increased cardiovascular disease risk in patients with CKD. However, the relationship between CACS and CKD progression has not been elucidated.

We studied 1936 participants with CKD (stages G1–G5 without kidney replacement therapy) enrolled in the KoreaN Cohort Study for Outcome in Patients With CKD. The main predictor was Agatston CACS categories at baseline (0 AU, 1–100 AU, and >100 AU). The primary outcome was CKD progression, defined as a ≥50% decline in eGFR or the onset of kidney failure with replacement therapy.

During 8130 person-years of follow-up, the primary outcome occurred in 584 (30.2%) patients. In the adjusted cause-specific hazard model, CACS of 1–100 AU (hazard ratio [HR], 1.29; 95% confidence interval [CI], 1.04 to 1.61) and CACS >100 AU (HR, 1.42; 95% CI, 1.10 to 1.82) were associated with a significantly higher risk of the primary outcome. The HR associated with per 1-SD log of CACS was 1.13 (95% CI, 1.03 to 1.24). When nonfatal cardiovascular events were treated as a time-varying covariate, CACS of 1–100 AU (HR, 1.31; 95% CI, 1.07 to 1.60) and CACS >100 AU (HR, 1.46; 95% CI, 1.16 to 1.85) were also associated with a higher risk of CKD progression. The association was stronger in older patients, in those with type 2 diabetes, and in those not using antiplatelet drugs. Furthermore, patients with higher CACS had a significantly larger eGFR decline rate.

Our findings suggest that a high CACS is associated with significantly increased risk of adverse kidney outcomes and CKD progression.

冠状动脉钙化评分 (CACS) 升高与 CKD 患者心血管疾病风险增加相关。然而，CACS 与 CKD 进展之间的关系尚未阐明。

我们研究了参加韩国 CKD 患者结局队列研究的 1936 名 CKD 参与者（G1-G5 期，无肾脏替代治疗）。主要预测因子是基线时的 Agatston CACS 类别（0 AU、1-100 AU 和 >100 AU）。主要结局是 CKD 进展，定义为 eGFR 下降 ≥50% 或替代治疗后出现肾衰竭。

在 8130 人年的随访中，主要结局发生在 584 名 (30.2%) 患者中。在调整后的特定原因风险模型中，CACS 为 1–100 AU（风险比 [HR]，1.29；95% 置信区间 [CI]，1.04 至 1.61），CACS >100 AU（HR，1.42；95% CI， 1.10 至 1.82）与主要结局的风险显着升高相关。与 CACS 的每 1-SD 对数相关的 HR 为 1.13（95% CI，1.03 至 1.24）。当非致命性心血管事件被视为时变协变量时，CACS 为 1–100 AU（HR，1.31；95% CI，1.07 至 1.60）且 CACS >100 AU（HR，1.46；95% CI，1.16 至 1.85）也与 CKD 进展的较高风险相关。这种关联在老年患者、2 型糖尿病患者和不使用抗血小板药物的患者中更为明显。此外，CACS 较高的患者 eGFR 下降率显着更大。

我们的研究结果表明，高 CACS 与不良肾脏结局和 CKD 进展的风险显着增加相关。